Resting sestamibi imaging for the prognosis of low-risk chest pain

Objective: To assess the prognostic value of resting Tc-99m sestamibi scann ing for adverse cardiac events (ACEs) in ED chest pain patients with a low probability of acute cardiac ischemia (ACI). Methods: Sixty-nine consenting , hemodynamically stable patients with chest pain and a nondiagnostic elect rocardiogram received an injection of 25 mCi of sestamibi during or within two hours of active pain. Scans were interpreted locally by a nuclear cardi ologist or radiologist. Interrater reliability was assessed. ACEs of myocar dial infarction (MI), death, or revascularization were assessed during the index hospitalization and over a one-year follow-up period. Results: For AC Es, rest scanning with sestamibi had a sensitivity of 71% (95% CI = 0.33 to 0.97), a specificity of 92% (95% CI = 0.82 to 0.97), and an accuracy of 90 % (95% CI = 0.87 to 0.99). The positive predictive value was 50% (95% CI = 0.19 to 0.82) and the negative predictive value was 97% (95% CI = 0.87 to 0 .98). Sestamibi scanning was highly discriminating, with 62% of patients wi th positive scans but only 3% with negative scans having ACEs (p < 0.001, l og rank test). Conclusion: In patients with low-risk chest pain, sestamibi scanning has good specificity and moderate sensitivity for ACEs over a 12-m onth period.